Gall Bladder

Introduction

Gall-bladder is a small organ lies just below liver on right upper abdomen. Gall-bladder stores bile (juice formed by liver) and help in digestion of fatty meals. Development of stones in gall-bladder indicates malfunction of gall-bladder and surgical removal of gall-bladder is easily tolerated by the body.Dr Avinash Tank For Laparoscopic Surgery in India, Laparoscopic Surgery in Gujarat, Laparoscopic Surgery in Ahmedabad.

Type of Gall-stones: There are 3 types of gall-stones.

Cholesterol gallstones develop when bile contains too much cholesterol and not enough bile salts. Risk factors for cholesterol stones are obesity, women taking estrogen either as family planning pill or for peri-menopausal hormonal supplement, diabetic person and those losing weight rapidly. Healthy lifestyle may minimize the development of cholesterol gall-stones.

Pigmented stone are made up of bilirubin and risk factors for pigment stones includes hemolytic anemias (such as sickle-cell disease and hereditary spherocytosis), cirrhosis (Liver failure), and biliary tract infections.

Mixed stones, is the most common type seen in Indian-Asian population. They are composed of both cholesterol and salts.

Risk Factor

Women between 20 and 60 years of age are twice as likely to develop gallstones as men.

Age: more common in the 30's & 40's.

Obesity

Excess estrogen (women on oral contraceptive pills etc.

Diabetes

Pregnancy

Rapid weight loss

Prolonged fasting

Hereditary blood disorders.

Symptoms

Biliary Colic: Gallstones may remains asymptomatic or may lead to "gallstone attack" (Biliary colic): an unforgettable intense pain in the upper-right side of the abdomen, often accompanied by nausea and vomiting, that steadily increases for approximately 30 minutes to several hours. Often, attacks occur after a particularly fatty meal.

Other symptoms include abdominal bloating, intolerance of fatty foods, belching, gas, and indigestion.

Diagnosis

Ultrasound is the most useful test to identify gallstones. Sometime MRCP / ERCP may be required to look for presence of stones in common-bile duct (CBD).

Acute Cholecystitis (Inflammation of the gallbladder). A gallstone that becomes lodged in the neck of the gallbladder can cause inflammation of the gallbladder (cholecystitis). In some case this may lead to pus formation in gall-bladder, leading to severe pain and fever that require hospitalisation and treatment.

Jaundice & Cholangitis (Blockage of the common bile duct & Fever).
Gallstones can block the tubes (ducts) through which bile flows from your gallbladder or liver to your small intestine. Jaundice and bile duct infection
(Cholangitis) can result.

Acute Pancreatitis (Blockage of the pancreatic duct). The pancreatic duct is a tube that runs from the pancreas to the common bile duct. Pancreatic juices, which aid in digestion, flow through the pancreatic duct. A gallstone can cause a blockage in the pancreatic duct, which can lead to inflammation of the pancreas (Pancreatitis). Pancreatitis causes intense, constant abdominal pain and usually requires hospitalization.

Gallbladder cancer. People with a history of gallstones have an increased risk of gallbladder cancer. But gallbladder cancer is very rare, so even though the risk of cancer is elevated, the likelihood of gallbladder cancer is still very small.

Treatment

Asymptomatic Gall-Stones

Asymptomatic gall-stones are usually observed. Only high risk asymptomatic patients (those having more probability to develop gall-stone related complications) are advised for surgery. The High risk asymptomatic patients are diabetic, person on chemotherapy & immunocompromised person (HIV).

Stone dissolving therapy in ineffective for mixed and pigmented gall-stones and has inconsistent result for cholesterol stones. Inability to identify stone composition and high prevalence of mixed stones, limits the use of "stone dissolving therapy" in Indian-Asian population.

Laparoscopic GB Surgery

Laparoscopic surgery is a minimally invasive approach to surgery. Several small incisions are made in the abdominal wall, through which are inserted tubes that allow the passage of the surgical instruments needed for the operation. A small camera is inserted into the abdomen, and the surgeon operates by watching his activities on a video monitor. To enhance his vision, your abdomen in inflated with gas, and as much as possible of this is expelled again at the end of the operation. However you may feel a bit bloated, or have "wind" pains under your diaphragm or in your shoulder tip for a few days whilst any final gas bubbles are slowly reabsorbed.

Compared to open surgery, benefits of laparoscopic surgery include

Less post-operative pain

Better cosmetic results

Fewer wound infections

Fewer incisional hernias

Faster recovery and return to pre-surgical levels of activity

Preparation for Surgery

Our expert team members shall help you to prepare you for surgery. You are strongly advised to stop smoking, stop drinking alcohol, try to improve your diet, lose weight, or actively exercise before surgery.

Pre-operative testing

In most cases, you will need some tests before your surgery. The tests routinely used include:

Blood tests to measure your blood counts, your risk of bleeding or infection, and how well your liver and kidneys are working.

USG (UltraSonoGraphy) is the standard test to know about gall-bladder stones.

Anaesthetic Assessment before Surgery:

Our expert team of Anaesthetist will ask you questions pertaining to your health and to assess your fitness for surgery. You are requested to tell them in detail about your current and past medical ailments, allergic reactions you've had in the past and current medicines that you are taking like blood thinning medicine. This medicine should be stopped 1 week prior to surgery.

Informed Consent

Informed consent is one of the most important parts of "getting ready for surgery". It is a process during which you are told about all aspects of the treatment before you give your doctor written permission to do the surgery.

Getting ready for Surgery

Depending on the type of operation you have, there may be things you need to do to be ready for surgery:

Emptying your stomach and bowels (digestive tract) is important. Vomiting while under anaesthesia can be very dangerous because the vomit could get into your lungs and cause an infection. Because of this, you will be asked to not eat or drink anything starting the night before the surgery.

Laxative: You may also be asked to use a laxative or an enema to make sure your bowels are empty.

Shaving of Operative part: You need to have an area of your body shaved to keep hair from getting into the surgical cut (incision). The area will be cleaned before the operation to reduce the risk of infection.

Anaesthesia

Anaesthesia is the use of drugs to make the body unable to feel pain for a period of time. General anaesthesia puts you into a deep sleep for the surgery. It is often started by having you breathe into a face mask or by putting a drug into a vein in your arm. Once you are asleep, an endotracheal or ET tube is put in your throat to make it easy for you to breathe. Your heart rate, breathing rate, and blood pressure (vital signs) will be closely watched during the surgery. A doctor watches you throughout the procedure and until you wake up. They also take out the ET tube when the operation is over. You will be taken to the recovery room to be watched closely while the effects of the drugs wear off. This may take hours. People waking up from general anaesthesia often feel "out of it" for some time. Things may seem hazy or dream-like for a while. Your throat may be sore for a while from the endotracheal (ET) tube.

Recovery from Surgery

Pain

You may feel pain at the site of surgery. We aim to keep you pain free after surgery with the help of latest and most effective technique or analgesic (pain relieving medicine).

Eating and Drinking

You will be allowed orally liquids once you recover from effect of anaesthesia medicine and you don't have nausea or vomiting. Gradually you can add soft to normal diet.

Activity

Our health care team will try to have you move around as soon as possible after surgery. You are encouraged to get out of bed and walk the same day. While this may be hard at first, it helps speed your recovery. It also helps your circulation and helps prevent blood clots from forming in your legs.

Going home

Once you are eating and walking, and then you are ready to go home, in most case in next day following surgery. Before leaving for home our health care team shall give you detailed guidance regarding diet, activities, medications & further plan of treatment

Risks and side effects of surgery

There are risks that go with any type of medical procedure and surgery is no longer an exception. Success of surgery depends upon 3 factors: type of disease/surgery, experience of surgeon and overall health of patients. What's important is whether the expected benefits outweigh the possible risks.

Complications in major surgical procedures include:

Complications related to Anaesthesia:Reactions to drugs used (anesthesia) or other medicines. Although rare, these can be serious because they can cause dangerously low blood pressures.

Complications related to Specific Operations: You are encouraged with discuss in detail with our health care team before you give your consent for surgery.

Conversion to open surgery: Although experienced surgeon can perform laparoscopic gall-bladder surgery, but are some situations that may justify to convert to open surgery like densely adherent nearby organ to gall-bladder that make identification of gall-bladder difficult to execute safe surgery.